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JAMA Insights
July 4, 2017

Penicillin Allergy Is Not Necessarily Forever

Author Affiliations
  • 1Department of Infectious Diseases, Austin Hospital, Melbourne, Victoria, Australia
  • 2Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  • 3John Hopkins Asthma and Allergy Centre, Baltimore, Maryland
  • 4Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
  • 5Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
JAMA. 2017;318(1):82-83. doi:10.1001/jama.2017.6510

Penicillin allergy is often diagnosed early in life, and the history of penicillin allergy persists in a patient’s medical record for many years without verification. Some physicians’ consideration of a patient having penicillin allergy is based on patient experience that may have occurred early in childhood. This results in the use of alternate antibiotics that are less effective, more toxic and expensive, and that have inappropriately broader coverage than penicillin.1 Accumulating evidence suggests that excessive use of unnecessarily broad-spectrum antibiotics increases the risk of antibiotic resistance, including Clostridium difficile infection.2 The inability to use an antistaphylococcal penicillin (eg, nafcillin) for patients with methicillin-susceptible Staphylococcus aureus sepsis or other serious infections for which penicillins are the first-line therapy (eg, ampicillin for Enterococcus faecalis or benzathine penicillin for syphilis) places patients at risk of treatment failure, resistance generation, and increased mortality.

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